Download Cosmetic correction of Anterior Staphyloma : A rare surgery

International J. of Healthcare and Biomedical Research, Volume: 05, Issue: 01, October 2016, 49-52
Case Report:
Cosmetic correction of Anterior Staphyloma : A rare surgery
*Dr. Aayush Tandon, **Dr. SomenMisra , **Dr. Neeta Misra
*Resident, ** Professor, Department of Ophthalmology
Rural Medical College, Pravara Institute of Medical Sceiences , Loni ( DU) , Maharashtra , India
Corresponding author: Dr. Aayush Tandon
Abstract
Anterior Staphyloma is an ectasia of pseudocornea which results after sloughing of cornea with iris plastered behind. Our patient presented with
loss of vision, white corneal opacity & abnormal bulging of the right eye since childhood following penetrating ocular trauma by a wooden
stick.Patient had come to the hospital only to seek cosmetic improvement. Clinical diagnosis of Anterior Staphyloma was made. After informed
written consent patient was taken up for surgery and a Evisceration was performed under local anaesthesia by placing a silicone orbital implant
within the scleral pocket.Patient was sent for customised ocular prosthesis after 2 months of surgery. A customised ocular prosthesis over the
well formed sclero -conjunctival pocket can bring back some amount of movement with complete cosmetic recovery which apparently appears
normal, thus an ocular prosthesis should be provided as soon as possible for the psychological well being of the patient.
Background
to complete loss of vision, 1 year post trauma. Patient had
A staphyloma is a clinical condition characterised by an
come to the hospital only to seek cosmetic improvement.
ectasia of the outer coats ( cornea or sclera or both ) of the
On general examination patient was averagely built and well
eye with
1
incarceration of the uveal tissue .The basic
nourished. Systemic examination for the respiratory system,
underlying pathology is weakening of the eye ball which can
cardiovascular
be caused by many inflammatory or degenerative diseases
abnormality. Ocular examination revealed thatvisual acuity
1
system,
and
abdomen
revealed
no
involving these structures . Corneal (anterior) staphyloma
of the patient was 6/6 in left eye and No PL in right eye.
can develop following small pox, corneal ulcer, trauma and
Left Eye findings were within normal limits.In the right eye
2
keratomalacia .Anterior Staphyloma is an ectasia of
Cornea was bulging forward between the lids .Exposed
pseudocornea( the scar formed from organised exudates and
portion of conjunctiva was lustreless.Cornea was opaque,
fibrous tissue covered with epithelium) which results after
thinned out and ectatic andiris tissue was adhered to the
2
sloughing of cornea with iris plastered behind . It can be
back of the cornea inferiorly .There was no vascularisation
complete or partial depending upon the part of the cornea
over the cornea (Photograph 1 & 2). Other details could not
involved
3.
be appreciated. Digitally the intraocular pressure was found
Case report
to be normal. Clinical diagnosis of Anterior Staphyloma was
A 21 year old female patient came to Pravara Rural hospital
made .
and presented with loss of vision, white corneal opacity &
After informed written consent patient was taken up for
abnormal bulging of the right eye since childhood. Patient
surgery and a Evisceration was performed under local
was having history of penetrating ocular trauma by a
anaesthesia by placing a silicone orbital implant within the
wooden stick in childhood followed by pain redness
scleral pocket. After application of proparacaine 0.5% and
watering from the same eye .After trauma she developed
povidone iodine 0.3% eye drops a four quadrant peribulbar
gradual painless progressive diminution of vision, white
block was given with 3ml of xylocaine 2% ⁄ adrenaline
opacity and abnormal bulging of right eye ultimately leading
1:200 000 in each quadrant. A speculum was placed
between the eyelids after painting draping under complete
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International J. of Healthcare and Biomedical Research, Volume: 05, Issue: 01, October 2016, 49-52
asepsis. A 360° peritomy was done using Wescott scissors.
scisso
implemented by us caused no complications. Patient was
Care was taken to preserve as much conjunctiva as possible.
called for customised ocular prosthesis after 2 months of
A full-thickness
thickness limbal incision was made with a 11 number
surgery.
blade scalpel. The remainder of the limbus was cut with
impression technique, which involved conversion of alginate
scissors, allowing for removal of the corneal button along
impression
ression into a wax model. The wax model was then
with adhered iris tissue (Photograph 3).. The intraocular
sculpted to match for its size (horizontally, vertically and
contents were then removed with the aid of an “evisceration
“evisc
antero-posteriorly)
posteriorly) and shape as close as possible to the
spoon” a round relatively flat curette (Photograph 4).
4)
normal eye; then the iris–corneal
corneal position was recorded.
Careful attention was given to the complete removal of all
Final wax model was moulded and the prosthesis was
uveal tissues( In theory this decreases (possibly
ssibly eliminates)
fabricated using medical grade acrylic material.8,9.The
the risk of sympathetic ophthalmia).
prosthesis were immersed in a disinfectant (Chlorhexidine
The inner surface of the sclera was then bathed in alcohol.
gluconate B.P 0.3% W/V, Cetrimide B.P 3.0% W/N) for 24
The purpose of this step is to denature any residual protein
h and rinsed with normal saline prior to insertion. After
that
is,
insertion of ocular prosthesis (Photograph 6 ))the patients
sympathetic ophthalmia. Sclerotomy
rotomy was performed at 3,6,9
was placed on topical antibiotics eye medications. FollowFollow
and 12 ‘0’ clock position allowing for placement of larger
up visits were scheduled at 1, 2 and 6 weeks and then 3
implant. PMMA ball was implanted in the empty scleral
months postoperatively. The patients was taught how to
pocket (Photograph 5) and Sclera was sutured end to end
remove and reinsert the prosthesis. S
She were also instructed
using silk 6-0 followed by conjunctival suturing by vicryl 8-
on what to do if there was any discharge from the socket at
0 covering the scleral wound.. Eye was pressure dressed and
a
any
ny time (such as removing the ocular prosthesis at night
bandaged for 48 h to prevent haemorrhage.. Patient was
and use of topical antibiotics and reportin
reporting to the hospital).
started on steroid - antibiotic drops and systemic
Patient wascounselled on the importance of maintain
maintaining a
analgesics/anti-inflammatory drugs post operatively and was
healthy socket by the way they handled the prosthesis.
might
discharged
otherwise
after
Photograph 1
Photograph 3
7
incite
days.
inflammation,
The
surgical
that
Prosthesis
was
fabricated
using
modified
procedure
Photograph 2
Photograph 4
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International J. of Healthcare and Biomedical Research, Volume: 05, Issue: 01, October 2016, 49-52
Photograph 5 Photograph 6 : Final Outcome
Discussion
staphyloma
A staphyloma is a clinical condition characterised by an
Evisceration with the placement of an orbital implant is the
ectasia of the outer coats (cornea or sclera or both
both) of the
most preferred treatment modality 6.
eye with
incarceration of the uveal tissue1. The basic
whileothers
others
are
scleral
staphylomas.
Most Surgeons prefer doing evisceration over enucleation,
underlying pathology is weakening of the eye ball which can
favouring
final
aesthetic
outcome
and
to
avoid
6
be caused by many inflammatory or degenerative diseases
complications of post-enucleation
enucleation socket syndrome . Eyes
1
involving these structures . Staphyloma are caused due to
are generally the first features of face to be noticed.
various conditions. Corneal (anterior) staphyloma can
Removal of this organ either due to tumors, trauma or any
develop following small pox, corneal ulcer, trauma
traum and
other condition not only cause unaesthetic look but causes of
2
keratomalacia .
Ocular
malignancies,traumatized
diseases
globes,
like
painful
intraocular
blind
function and has a psychological effect on the patient
eyes,
7
.
Thus, ocular prosthesis should be provided as soon as
staphylomas, disfigured globes, etc. are the common
possible for the psychological well being of the patient.
indications for eye removal surgeries (i.eenucleation
enucleation or
Conclusion
evisceration). These procedures can be performed along
Anterior staphyloma is not cosmetically acceptable in the
with the placement of an orbital implant wherever indicated
population especially among young ones. After evisceration
depending on the underlying cause
4,5
.
of anterior staphyloma an implant of PMMA ball was
Staphylomas, one of the clinical indications for eye removal,
implanted within the scleral pocket to maintain approximate
clinically present with a localizedbulging or protrusion of
shape and movement
nt of the globe. A customised ocular
globe. It is an infiltration
iltration of the uveal tissue through weak or
prosthesis over the well formed sclero -conjunctival pocket
thinned out outer coat (cornea or sclera). They can be either
can bring back some amount of movement with complete
congenital or acquired, and also can be unilateral or
cosmetic recovery which apparently appears normal. In this
bilateral. Depending on the site of lesion,staphylomas can be
patient, we have tried the above mentioned proc
procedure with
categorized under anterior,intercalary,
calary, ciliary, equatorial and
good cosmetic outcome. We recommend the same for
2
posterior Staphyloma . Anterior staphyloma is a corneal
cosmetic reconstruction, particularly among young patients.
References
1.Sihota-Tandon.
Tandon. ‘Parson’s diseases of eye’. 22nd edition 2015 :229
2. Pramod TK.’ Best Aid to Ophthalmology’ 1st edition 2013 : 130
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.Mukherjee PK. Clinical Examination in Ophthalmology. Elsevier Health Sciences;2006:63-83
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ISSN: 2319-7072
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International J. of Healthcare and Biomedical Research, Volume: 05, Issue: 01, October 2016, 49-52
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